Prevalence of Patent Foramen Ovale in Patients with Non-Obstructive Coronary Artery Disease (PROVA) Study

• Published in: Journal of cardiovascular development and disease Vol. 12; no. 4; p. 108
• Main Authors: el Bouziani, Abdelhak, Witte, Lars S., Feenstra, Rutger G. T., Renkens, Mick P. L., Woudstra, Janneke, Tijssen, Jan G. P., Vink, Arja S., Appelman, Yolande, Grundeken, Maik J. D., Straver, Bart, Piek, Jan J., Bouma, Berto J., de Winter, Robbert J., Beijk, Marcel A. M.
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 21.03.2025; MDPI
• Subjects: Angina pectoris; angina pectoris with no obstructive coronary artery disease; Cardiac patients; Cardiovascular disease; Cohort analysis; coronary artery spasm; Coronary vessels; Diseases; Drug dosages; Electrocardiography; Medical imaging; Medical research; Medicine, Experimental; Metabolites; Migraine; migraine with aura; Netherlands; patent foramen ovale; Patients; Questionnaires; right-to-left shunt; Vein & artery diseases; Netherlands; United States > US; migraine with aura; patent foramen ovale; angina pectoris; right-to-left shunt; angina pectoris with no obstructive coronary artery disease; coronary artery spasm
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd12040108

(1) Background: Prevalence of patent foramen ovale (PFO) in the general population is estimated at around 24%. We hypothesized that right-to-left shunting (RLS) resulting from PFO might contribute to angina symptoms in patients with coronary artery spasm (CAS), potentially triggered by vasoactive metabolites. Therefore, the aim of this study was to investigate the prevalence of PFO-related RLS in patients with documented CAS. (2) Methods: This single-center prospective cohort study included patients with documented CAS undergoing transthoracic echocardiography (TTE), including a contrast bubble study between 2021 and 2023. The Seattle Angina Questionnaire (SAQ) and Migraine Disability Assessment (MIDAS) were used to survey patients. (3) Results: RLS (PFO group) was observed in 11 of the 48 patients included (23%). In the PFO group, 64% had epicardial spasm and 36% microvascular spasm. Furthermore, RLS was more prevalent in patients with CAS and concomitant migraine (29%). Remarkably, the density plot of the SAQ summary score showed a worse score for patients with RLS (median of 38 [Q1–Q3: 31–49]) than patients without RLS (median of 49 [Q1–Q3: 41–55]) (p = 0.0282). (4) Conclusions: The prevalence of RLS due to PFO in patients with CAS was in line with the PFO prevalence in the general population, and patients with RLS are more symptomatic according to the SAQ summary score. Whether PFO closure could be beneficial to patients with CAS and concomitant migraine requires further investigation.